Provider Demographics
NPI:1750381745
Name:GRULKE, ALEXANDRA KAY (DPM)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:KAY
Last Name:GRULKE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 W NIELDS ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-2128
Mailing Address - Country:US
Mailing Address - Phone:610-431-0200
Mailing Address - Fax:610-431-9333
Practice Address - Street 1:708 W NIELDS ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-2128
Practice Address - Country:US
Practice Address - Phone:610-431-0200
Practice Address - Fax:610-431-9333
Is Sole Proprietor?:No
Enumeration Date:2005-07-30
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004828L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101205767 0001OtherPUBLIC WELFARE
PAVO4115Medicare UPIN